Healthcare for Alzheimer's Patients in the United States

Alexa Jones

Fall 2023

While working at a nursing and rehabilitation home, I met a multitude of residents with varying degrees of memory and general healthcare needs. Some patients could walk around and coherently communicate, while others were elderly and only required short-term monitoring and care. For instance, Buddy explored every floor of the nursing facility, scamming strangers into buying him snacks from the vending machine and asking the dietary staff for extra ice cream. On the other hand, there were patients such as Janet, who never seemed to know where she lived or the names of the other residents she had lived with for months. Janet, like many other patients residing at this nursing home, lived in the Alzheimer's and Dementia ward.

Alzheimer's Disease (AD) is a progressive disease and the leading cause of dementia. AD currently affects approximately six million people in the United States and is projected to reach fourteen million by 2060 (“What is Alzheimer's Disease?”, 2020). This is a frightening statistic, as Alzheimer's Disease is the sixth leading cause of death among adults and the fifth leading cause of death of people over sixty-five in the U.S. (“What is Alzheimer's Disease?”, 2020). Though Alzheimer's is common in the U.S. and a significant cause of death for the country’s aging population, scientists are currently unaware of the exact cause of the disease. AD affects parts of the brain that control thought, memory, and language, resulting in memory loss, decreased judgment abilities, and mood, personality, or behavior changes that make it challenging to complete daily tasks. Additionally, while the cause of Alzheimer’s Disease is unknown, what has been determined is that AD is linked, for the most part, to age. Symptoms can appear as early as sixty, with the chance of acquiring the disease doubling every five years past sixty-five (“What is Alzheimer's Disease?”, 2020). AD is also hereditary, as those who have or have had relatives with the disease are predisposed to it. However, chances for developing the disease may be lowered with a healthy lifestyle, though more research must be done before any concrete conclusions are concluded.

 As Alzheimer’s Disease is an impactful disease in the U.S., there must be different healthcare options for afflicted patients. The burden of Alzheimer’s Disease is exponential on both the patients and the friends and families of those affected. As people may be unable to fully care for their loved ones, delegating healthcare responsibilities to professionals may be the best option. The type of care intensity for those affected by progressive diseases such as Alzheimer’s or dementia is far different than general geriatric care. Therefore, at-home care for Alzheimer’s patients can be complicated and emotionally tiring for those involved in care. However, many different options for Alzheimer's care exist beyond at-home patient care. Care options span different levels, including retirement housing, assisted living, nursing homes, and specialized memory care facilities. For those facing early, mild symptoms of AD increased contact with others, and minimal care, retirement housing may be the best option. As symptoms progress and patients need more care, assisted living housing is a promising option. This type of healthcare for these patients bridges the gap between free-living and intensive care (“Long-Term Care,” 2023). However, assisted living homes do not necessarily guarantee Alzheimer's and dementia care expressly, as geriatric memory care is vastly different from general geriatric care. Exploring each home is necessary before committing an individual to a particular home. 

Due to the disparity in general versus memory geriatric care, even if patients suffering from AD have lower-level symptoms of the disease, higher-level professional care may be required. The type of care that is more intensive, and the care I have personally encountered, is included in nursing home residency. Nursing home residency involves around-the-clock care and long-term treatments by medical professionals (“Long-Term Care,” 2023). Lastly, if AD symptoms have intensely progressed and an individual is in a later stage of the disease (or if the patient or their relatives desire more intensive care), Alzheimer’s specialized care units (SCUs) could be a suitable option. Memory care can be viewed as an extension of assisted living, where care is specifically targeted to individuals with dementia or Alzheimer’s Disease (“Memory Care vs. In-Home Care for Dementia: What’s the Difference,” 2023). SCUs involve around-the-clock support and monitoring by medical professionals like nursing homes, but they can also provide further amenities catered towards memory care. Further amenities include increased security (to prevent patients from wandering or escaping the facility), structured cognitive programming, and occupational and physical therapy (“Memory Care vs. In-Home Care for Dementia: What’s the Difference,” 2023). 

Unfortunately, geriatric memory care can be highly inaccessible for many people affected by Alzheimer’s Disease. For instance, the economic barrier to AD and dementia care is highly significant. In 2022 alone, the cost of treatment was $321 billion, with costs projected to exceed $1 trillion by 2050 (Skaria, 2023). On average, in 2021, the annual cost for care for those suffering from AD is approximately $ 41,757 (three times higher than care for those not affected by AD). Although the benefits of Medicare or Medicaid are significant for AD patient care (being responsible for 50% and 23% of the overall cost, respectively), Medicare may not even be the leading supplier of the long-term care costs associated with treatment. The economic burden of patients and families caring for relatives with AD is especially burdensome, with the out-of-pocket cost being approximately 25% of the total cost of care, averaging $95,000 to $108,405 per year in 2021 (Skaria, 2023). Economic barriers to adequate healthcare for Alzheimer’s patients are not the only issue to memory care. For instance, patients afflicted with this disease who are not non-Hispanic White people have reported discrimination in care. Specifically, 50% of Black Americans, 42% of Native Americans, 34% of Asian Americans, and 33% of Hispanic Americans affected with Alzheimer’s disease have reported discrimination in healthcare. On the other hand, non-Hispanic White Americans reported discrimination at 9%, a much lower rate (Barriers to Equity in Alzheimer’s and Dementia Care, 2021). Thus, healthcare workers must train to appropriately care for different races and ethnicities and increase the diversity pool amongst healthcare workers and participants in clinical trials for Alzheimer’s patient care to ensure a safe, inclusive healthcare environment. 

Overall, there is still a lot unknown about Alzheimer’s Disease and care for those with geriatric memory diseases. In addition, there are still significant barriers to healthcare for those with Alzheimer’s and dementia; it can be difficult for afflicted patients to receive adequate care. Navigating Alzheimer’s disease can be a troublesome journey for both patients and their families, and deciding on what to do for a loved one affected by AD can be a difficult decision. Memory and geriatric care workers are essential to our country. However, a substantial amount of work still needs to be done to understand and care for our diverse population of those with Alzheimer’s. Patients like Janet should receive the Alzheimer’s Disease healthcare that they deserve. 

References

Barriers to Equity in Alzheimer's and Dementia Care. (2021, June 2). Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/barriers-to-equity-in-alzheimers-dementia-care/index.html. 

Long-Term Care. (2023). Alzheimer's Association. https://www.alz.org/help-support/caregiving/care-options/long-term-care. 

Memory Care vs. In-Home Care for Dementia: What’s the Difference?. (2023). Care Partners. https://carepartners.us/memory-care-vs-in-home-care-for-dementia-whats-the-difference/. 

Skaria, Anita Pothen. (2022, Sept. 22). The Economic and Societal Burden of Alzheimer Disease: Managed Care Considerations. Life Sciences. https://www.ajmc.com/view/the-economic-and-societal-burden-of-alzheimer-disease-managed-care-considerations. 

What is Alzheimer’s Disease?. (2020, Oct. 20). Centers for Disease Control and Prevention. https://www.cdc.gov/aging/aginginfo/alzheimers.htm.